Belarus has a poor standard of healthcare and fails to meet its population’s needs. Healthcare was neglected during Communist rule and consequently staffs are poorly trained, technology is outmoded and healthcare buildings are not very hygienic. In addition, Belarus has had to cope with the added pressure of the Chernobyl nuclear power plant accident, which not only caused many casualties in 1986, but wider medical repercussions years later.
The Ministry of Health is in charge of managing the health sector through health departments belonging to the Regional and Minsk Municipal Executive Committees. The 1993 healthcare law maintains that public spending on healthcare should not be less than 10 percent of the national income. All citizens in Belarus have the right to free health care in state-funded institutions.
The National Health Service
The health service is funded through general taxation. The Ministry of Health and the Ministry of Finance agree the health sector budget and then determine the percentage of tax revenue that will be given to healthcare.
Unlike most other countries in Europe, employees are not required to contribute to the health budget. All citizens and registered residents of Belarus are entitled to a wide-ranging package of free health care benefits in state-funded institutions. Medicines prescribed for outpatients, some dental services including false teeth, cosmetic surgery, spectacles, visits to health resorts and some preventive examinations will incur costs. The government decides what each group of society receives in terms of health services.
Citizens who belong to vulnerable groups of society e.g. pregnant women, war veterans, diabetics and tuberculosis patients do not have to pay any charges. Parents must, however pay part of the cost for their children’s prescription medicines. Most people accept that cosmetic surgery and visits to health care resorts are non-essential treatments, but the majority of the population disagree with being charged for outpatient prescription drugs. This unfair system encourages people to postpone treatment or seek admission to hospital, because all drugs prescribed in hospital are free.
Citizens can buy private health insurance to supplement the state system and to cover them for the services deemed non-essential. However, not many people have the means to do this and the volume of private healthcare in Belarus is insignificant and is limited to a few rich individuals and a small minority of employees, who receive private healthcare as a benefit of their job.
There are around 41,700 doctors and nearly 111,000 junior medical staff - a large number for a population of this size. Belarus has 511 outpatient clinics, 372 of which are rural polyclinics. There are also 732 outpatient departments in hospitals, 422 of which are in rural hospitals.
There is a huge financial burden on medical care, which has allegedly led to an unequal rationing of treatment. Some doctors have chosen to treat one patient in favour of another. The patient is chosen according to traditional medical criteria like age, survival rate and complications. Sometimes when the criteria between two patients are similar, doctors choose to treat the wealthier of the two patients.
The practice of making ‘under-the-table’ payments is prevalent and thus the poorest members of society are barred from treatment.
Doctors have not fully developed their roles as family counsellors or general practitioners and consequently people lack confidence in their abilities and frequently refer themselves to consultants and specialist doctors.
Rural Health Centres
Rural health institutions provide emergency medical service, first aid and basic outpatient care to the people residing in villages and small towns. They provide people with routine health checks, maternity care, immunisation, and first aid, treatment of minor injuries, round-the-clock emergency cover and home visits. Health posts refer patients in need of more complex procedures to a hospital.
Doctor-led practices serve the larger rural districts. These practices often have their own small hospital wing for inpatient care. Such health stations are usually staffed by nurses and a general practitioner who treats adults and a general paediatrician, an obstetrician and a midwife.
Many doctors stationed in the rural health centres are only recently qualified and are seldom qualified as general practitioners. They often treat conditions that are more complex for their skill levels. They are involved in childbirth, when there are no associated risks to the pregnancy and minor surgery.
The country has 834 hospitals providing over 125,000 beds. The conditions in some hospitals are extremely deprived. Patients have to provide their own crockery, cutlery and food. Hospital staff are often rude and inattentive.
By law, hospitals can charge patients for any care that they deem is non-essential. However, not many hospitals do this because so few people can afford to pay for medical services and in the past, any profit the hospital made was heavily taxed by the state. They also have poor administrative structures, which makes it difficult for them to collect fees.
Polyclinics provide the treatment for residents of towns. They also provide specialised medical services for residents of an entire administrative district. The polyclinic staff is made up of general practitioners known as uchastok, non-specialist obstetricians, midwives, nurses and social workers.
The polyclinic provides routine health checks, health education, immunisation, sickness certification, home visits, antenatal and obstetric care. Most standard polyclinics have a range of specialists, which includes cardiologists, gastroenterologists and oncologists. Polyclinic dentists provide basic dental services although all adults have to pay for their dental care.
Chemists are known as Pharmaceya in Belarus. There is a network of government and privately owned pharmacies all over the country. Seven state-owned companies manufacture drugs and they own more than 4,300 chemists. There are 1,500 private pharmacies. Citizens have to pay for all of the medicines sold through a chemist, but the government has determined that certain vulnerable groups including some people with long-term illness should receive free or reduced-price medicine.